Other areas of interest of mine research wise, a strong area of interest of mine has been specific kind of lymphoma called mantel cell lymphoma, and there are lots of different kinds of lymphomas which make it a complicated area to study and a complicated area to treat. And mantel cell lymphoma is a particular sub type of non-Hodgkin's lymphoma that has a relatively poor outcome. It's only been recognized as a unique lymphoma for about the last 15 years, I mean it's been around forever but they just didn't have the tools to recognize this as a distinct entity, you know 20-25 years ago. But now because of improved diagnostics we can pick this one out of the bunch and say ah ha that's a case of mantel cell lymphoma. So once we're able to sort that out and separate that out it didn't take long to realize that patients with this one do, don't do as well as other types. And a study that came out about 10 years ago showed mantel cell lymphoma had the worst 5 year survival rate of any lymphoma sub type. So, when I was a new faculty member about 8 years ago I immediately started thinking about trying to come with better ways to treat mantel cell lymphoma that was one of the first things I started working on. So we did a study um several years ago which we've published now in which we came up with a novel treatment strategy for mantel cell lymphoma. And we showed that on average with our regimen people would stay in remission for about 3 years, on average, which was actually an advance. The previous regimens that had been used were showing remissions of only about a year and a half, so we had essentially doubled that. And a lot of the early data showed that the patient's were only living on average 3 years, so we thought 3 years of your first remission was a good advance. So we published that but obviously there are lots of room for improvement there, and around the same time we finished that study along came another drug that looked interesting to us for mantel cell lymphoma, and that drug is called Bortezomib. And Bortezomib which goes by the trade name Velcade is a class of drug that is called proteasome inhibitors and so this drug attacks a new targeted cancer cells that no other drug attacks. Sort of a first in class agent, brand new way to try to kill cancer cells. Bortezomib was already approved for a disease called multiple myeloma which is related to lymphoma. And we helped participate in a study in which we gave Bortezomib to patients with relapsed mantel cell lymphoma and what we helped show in that study is that about 30-40% of patients getting Bortezomib with relapse mantel cell lymphoma would go back into remission, that is actually an encouraging result, because relapse mantel cell lymphoma is notoriously hard to treat. So, around the, we were finishing our first frontline trial and this Bortezomib study for relapse mantel cell we're getting done all at about the same time and we had participated in both of those. So we had an idea to try to take Bortezomib this new promising drug and combine it with the regimen that we had been giving for newly diagnosed patients, and so that was a study that I initiated about a little over 3 years ago now, and so this new regimen we call VC, VC for Velcade, VCRCVAD, the rest of the letters stand for the chemo drugs. So we've been using this VCRCVAD regimen for our newly diagnosed mantel cell lymphoma patients for the last 3 years, and because I have a little bit of a reputation for a, as an expert in mantel cell lymphoma I get a lot of referrals for mantel cell lymphoma, so even though it's a rare lymphoma I see a fair bit of it and we see about one new mantel cell lymphoma patient a month, which is a lot, for that sub type. So, I've just written this up for presentation at national meeting coming up in a few months and so our VCRCVAD regimen looks like it got close to 80% of people in complete remission and about 90% of patients in to some kind of remission. And when we compare it to the study that we did before this actually looks a little better. It looks like we've improved that, so there's a signal that the addition of the Bortezomib to the regimen might be helping to produce better quality remissions. And so we're very interested to keep developing this and moving this forward in mantel cell lymphoma. And um we're so excited about this one that we took this VCRCVAD regimen to ECOG, the Eastern Cooperative Oncology Group and said look here's something that we've developed at the University of WI we think this looks promising, um and so lets really put it to the test. Its one of the things that's generally true of clinical research and clinical trials, sometimes when you do a study at a single institution the results somewhat can be overly optimistic, um and you really need to take these regimens out to many centers to get a true sense of how effective a regimen really is. And so we're very anxious to see how this new regimen VCRDVAD will hold up in the cooperative group setting. And so we took the VCRDVAD regimen to ECOG, it was approved again and now we've initiated that study in the Eastern Cooperative Oncology Group and that's currently underway. Um, and so um there's another example of an area of research interest of mine. Another thing I am very interested in exploiting in mantel cell lymphoma, sticking with mantel cell lymphoma for a moment, is the idea of how to maintain someone in remission once they've established remission. One of the vexing things about mantel cell lymphoma is you know getting the folks into remission is one thing but keeping them in remission is even harder. And so one of the things we had done with our original mantel cell lymphoma study was to give them 2 years of what we call maintenance Rituxuimab, so I mentioned that drug Rituxuimab earlier, that's the monocle antibody that has a very favorable side effect profile. So it's an attractive strategy to administer to patients as a way to try to maintain the remission because you can give this drug over and over and over with really without a detrimental effect on quality of life, you know a drug that maintains remission but has a negative effect on quality of life because of side effects isn't a very useful drug for maintaining remission. I mean we want people to be in remission and be in remission and feeling good, we want it both ways. So Rituxuimab is a good drug from that standpoint, and so we were the first center in the world to try Rituxuimab as a maintenance strategy in mantel cell lymphoma. And my belief is that it actually helps keep people in remission and we're trying to do bigger studies now that will support that and improve it eventually. Um so that's a big area of interest of mine is maintenance Rituxuimab for mantel cell lymphoma. For more information go to www.forwardlymphoma.org .
